Knowledge is power. By arming ourselves with awareness and taking proactive steps, we can work toward reversing this troubling trend and protecting the health of future generations.
Dr. Amir Bista, ThedaCare Cancer Care
A concerning trend has emerged in recent years: a significant increase in colorectal cancer cases among younger adults. Colorectal cancer, traditionally seen as a disease of older individuals, has become the leading cause of cancer death among people under 50.
In 2023, the American Cancer Society (ACS) reported that 20% of diagnoses in 2019 were in patients under age 55 — about double the rate in 1995. In addition, rates of advanced disease increased by about 3% annually in people younger than 50.
Dr. Amir Bista, a physician specializing in hematology, oncology, and internal medicine with ThedaCare Cancer Care, has seen the trend play out in his practice.
“I have had young patients who were diagnosed at the advanced stages of the disease because they didn’t realize their symptoms were potentially serious,” he says. “Conversely, I have also had patients who were diagnosed very early when they underwent the recommended colonoscopy early in life due to family history of colon cancer.”
Startling Statistics
The ACS projects that around 151,000 Americans will be diagnosed with colorectal cancer in 2024. The number of older adults diagnosed with colorectal cancer has been decreasing since the 1980s. However, cases in people younger than 55 have been increasing by 1% to 2% per year since the mid-1990s.
Advocacy group Fight Colorectal Cancer reports that the incidence of early-age onset colorectal cancer — diagnoses under age 50 — is expected to increase by more than 140% by 2030. More than 27,000 people under age 50 will be diagnosed with colorectal cancer in 2030, up from 18,000 per year in 2020.
Experts say that diagnosis in young people often is delayed even though individuals present with classic symptoms of abdominal pain, rectal bleeding, and changes in bowel habits. These younger patients may also have age-specific disease management challenges such as fertility, pregnancy, sexual health, financial concerns, and long-term survivorship.
Risk Factors
While the exact reasons behind the surge are not entirely clear, several contributing factors are believed to play a role.
- Genetic predisposition: The most common risk factor is a family history of colorectal cancer (mainly), Dr. Bista says. About one-fourth of younger adults with the disease are thought to have genetic risk factors. These include certain genetic syndromes such as Lynch syndrome, familial adenomatous polyposis (FAP), and others.
- Unhealthy diet: This is characterized by overconsumption of processed foods, red meat, and sugary beverages. A diet low in fiber and high in saturated fats can contribute to inflammation and damage to the colon and rectum over time.
- Sedentary lifestyle: Culprits include excessive screen time, prolonged sitting, and reduced physical activity. Lack of exercise can lead to weight gain and obesity, which are known risk factors for the disease.
- Environmental factors: These include pollution, exposure to harmful chemicals, and increased use of antibiotics. These factors can disrupt the balance of gut bacteria and promote the growth of cancerous cells.
“In recent years in Northeast Wisconsin — as in other parts of the country — we have seen more obesity and sedentary lifestyles among children and adolescents,” Dr. Bista says. “We cannot overlook these factors as leading to an increased risk for early-onset colorectal cancer cancer.”
Smoking, overconsumption of alcohol, and excessive use of antibiotics also pose risks, he continues.
Prevention and Early Detection
Despite the concerning trend, younger adults can take steps to reduce their risk of developing colorectal cancer and detect the disease early, Dr Bista says.
- Healthy lifestyle choices: This includes getting regular exercise, eating a balanced, high-fiber diet, and maintaining a healthy weight. Limit the consumption of processed meats and alcohol, and quit smoking.
- Regular screening: While routine screening for colorectal cancer typically begins at age 45, people with a family history of the disease or other risk factors may need to start screening at an earlier age. Colonoscopy is considered the “gold standard” for detecting the disease. Other options include fecal occult blood tests and stool DNA tests.
- Awareness and education: Colorectal cancer begins as an abnormal growth known as a polyp, typically in the large intestine. It could become malignant and spread throughout the body. Among younger patients, there is a higher incidence of the cancer on the left side of the colon and rectum, so the main symptoms typically are bright red blood in the stool and abdominal pain. These symptoms could mimic less-severe medical conditions such as hemorrhoids or constipation.
“If any of these symptoms persist for weeks or recur, see your primary care physician,” Dr. Bista says. “They might refer you to a surgeon or GI specialist for a more detailed examination.”
Don’t Delay Care
The American Cancer Society found that about four in 10 people of eligible age are not up to date on colorectal cancer screening.
“The rate of noncompliance seems to be higher in young people,” Dr. Bista says.
He adds that other research has shown that this higher noncompliance rate has led to diagnosis at an advanced stage in younger people. This significantly decreases the rate of care and survivorship. In addition, as these individuals age, they will have an elevated risk for the rest of their lives.
“Knowledge is power,” Dr. Bista says. “By arming ourselves with awareness and taking proactive steps, we can work toward reversing this troubling trend and protecting the health of future generations.”
